Lau Siew Yan, Bee Boon Cheak, Wong Hin-Seng, Omar Marhanis Salihah, Bahari Norazlah
Department of Pharmacy, Selayang Hospital, Selayang, Malaysia.
Department of Nephrology, Selayang Hospital, Selayang, Malaysia.
Int J Nephrol. 2022 Apr 11;2022:8985178. doi: 10.1155/2022/8985178. eCollection 2022.
Coagulase-negative (CoNS) are frequently isolated in peritoneal dialysis (PD)-related peritonitis with a high rate of relapse and repeat peritonitis after initial response to antimicrobials. The optimal treatment regimen for CoNS peritonitis remains debatable. Hence, this study aimed to describe the clinical and microbiologic characteristics of CoNS peritonitis in a PD center and determine predictive factors influencing the outcomes.
All cases of CoNS peritonitis in Selayang Hospital between 2011 and 2019 were reviewed retrospectively.
A total of 906 episodes of peritonitis were recorded; 140 episodes (15%) in 98 patients were caused by CoNS. The oxacillin and gentamicin resistance rates were 47% and 46%, respectively. The overall primary response rate was 90%, and the complete cure rate was 79%. Patients with concomitant exit-site infection (odds ratio (OR) 0.06, 95% confidence interval (CI) 0.01 to 0.40, < 0.01) and history of recent systemic antibiotic use (OR 0.04, 95% CI 0.01 to 0.82, =0.04) were less likely to achieve primary response. CoNS episodes that were treated with beta-lactam-based or vancomycin-based therapy had a similar primary response rate and complete cure rate. The rates of relapse and repeat were 12% and 16%, respectively. Relapsed episodes (OR 0.35, 95% CI 0.13 to 0.97, =0.04) had a significantly lower complete cure rate than the first episodes.
Relapsed CoNS peritonitis was common and was associated with worse outcomes than the first episode of CoNS peritonitis. Oxacillin resistance was common, but the treatment outcome remained favourable when a beta-lactam-based regimen was used as empirical therapy.
凝固酶阴性葡萄球菌（CoNS）在腹膜透析（PD）相关性腹膜炎中常被分离出来，在初始对抗菌药物产生反应后复发率和重复发生腹膜炎的几率很高。CoNS腹膜炎的最佳治疗方案仍存在争议。因此，本研究旨在描述一家PD中心CoNS腹膜炎的临床和微生物学特征，并确定影响预后的预测因素。
回顾性分析2011年至2019年在士拉央医院发生的所有CoNS腹膜炎病例。
共记录了906例腹膜炎发作；98例患者中的140例发作（15%）由CoNS引起。苯唑西林和庆大霉素耐药率分别为47%和46%。总体初始反应率为90%，完全治愈率为79%。伴有出口处感染的患者（比值比（OR）0.06，95%置信区间（CI）0.01至0.40，P<0.01）和近期有全身使用抗生素史的患者（OR 0.04，95%CI 0.01至0.82，P=0.04）不太可能实现初始反应。采用基于β-内酰胺类或基于万古霉素的治疗方法治疗的CoNS发作具有相似的初始反应率和完全治愈率。复发率和重复发生率分别为12%和16%。复发发作（OR 0.35，95%CI 0.13至0.97，P=0.04）的完全治愈率明显低于首次发作。
CoNS腹膜炎复发很常见，且与首次CoNS腹膜炎发作相比，预后更差。苯唑西林耐药很常见，但当使用基于β-内酰胺类的方案作为经验性治疗时，治疗结果仍然良好。
